Ohio Administrative Code Search

...(A) Definitions. (1) "Private transportation vendor (PTV)" is an entity that meets the following criteria: (a) It seeks to establish or to maintain a contract with a county department of job and family services (CDJFS) to supply transportation service to medicaid recipients in accordance with rule 5160-15-10 of the Administrative Code; and (b) It is not a government agency, transit authority, p...

...(A) Definition. "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (B) Transportation-specific criteria. For each entity enrolled as an eligible provider of transportation services, the following conditions are met: (1) The entity, each crew member, and each attendant comply with all applicable local, state, and federal laws, regulations, and rules, inc...

...(A) Payment may be made for the following wheelchair van services: (1) Transport by wheelchair van; (2) Mileage, wheelchair van; and (3) Attendant services, wheelchair van. (B) Payment may be made only if all the conditions in this paragraph are met. (1) The necessity of the wheelchair van service is established. A necessary wheelchair van service is presumed to satisfy the criteria ...

...(A) Payment may be made for the following ground ambulance services: (1) Basic life support, provided in a non-emergency (BLS non-emergency); (2) Basic life support, provided in an emergency (BLS emergency); (3) Advanced life support, level 1, provided in a non-emergency (ALS1 non-emergency); (4) Advanced life support, level 1, provided in an emergency (ALS1 emergency); (5) Advanced life ...

...(A) No payment can be made for the following services and associated costs: (1) Transportation services for an individual who is not medicaid-eligible at the time of transport; (2) Transportation of a medicaid-eligible individual for a purpose other than the receipt of medicaid-coverable services; (3) Transportation of a medicaid-eligible individual to or from a service provided outside the...

...(A) Certification is needed to confirm the necessity of wheelchair van services and most non-emergency ambulance services. No certification is needed for transportation services furnished by an eligible provider that are automatically deemed to be necessary in accordance with rule 5160-15-22, 5160-15-23, or 5160-15-24 of the Administrative Code. A medicaid managed care organization (MCO) is not ob...

...(A) Purpose. This rule implements section 5164.96 of the Revised Code regarding supplemental medicaid payments to eligible emergency medical services organizations operated by a government entity. (B) Definitions applicable to this rule. (1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (2) "Ground ambulance transport" comprises the following ...

...(A) Definitions. (1) "Freestanding birth center (FBC)" has the same meaning as in 42 U.S.C. 1396d(l)(3)(B) (October 1, 2016). (2) "Independent practitioner" and "non-independent practitioner" have the same meaning as in rule 5160-4-02 of the Administrative Code. (3) "Low-risk expectant mother" has the same meaning as in rule 3701-83-33 of the Administrative Code. (B) Provider requirements....

...(A) Definitions. (1) "Freestanding birth center (FBC)" is an entity defined in 42 U.S.C. 1396d(l)(3)(B) (in effect as of January 1, 2023) that is operated in conformity with rules 3701-83-33 to 3701-83-42 of the Administrative Code. (2) "Independent practitioner" and "non-independent practitioner" have the same meaning as in rule 5160-4-02 of the Administrative Code. (3) "Low-risk expectant...

...(A) This rule defines coverage and payment for providers who meet the provisions in sections 5103.60, 5103.602, 5103.603, 5103.6010, 5103.6011, 5103.6017 and 5103.6018 of the Revised Code and the provisions described in this rule. (B) Definitions. For the purpose of this rule the following definitions apply: (1) "Clinical Director" is a practitioner of physician services who supervises day-t...

...(A) For purposes of rules 5160-19-01 and 5160-19-02 of the Administrative Code, the following definitions apply: (1) "Attribution" is the process through which medicaid recipients are assigned to specific PCPs who are able to participate in the medicaid program in accordance with rule 5160-1-17.2 of the Administrative Code. ODM is responsible for attributing fee-for-service recipients; MCOs are r...

...(A) For purposes of rules 5160-19-01 and 5160-19-02 of the Administrative Code, the following definitions apply: (1) "Attribution" is the process through which medicaid recipients are assigned to specific primary care practitioners (PCPs) who are able to participate in the medicaid program in accordance with rule 5160-1-17.2 of the Administrative Code. The Ohio department of medicaid (ODM) is res...

...(A) A comprehensive primary care (CPC) entity has to be enrolled and meet the provisions set forth in rule 5160-19-01 of the Administrative Code to be eligible for patient centered medical home (PCMH) payments. (B) A CPC entity participating in the CPC for kids program has to be enrolled as a CPC entity and meet all provisions set forth in rule 5160-19-01 of the Administrative Code to be eligible...

...(A) A comprehensive primary care (CPC) entity has to be enrolled and meet the provisions set forth in rule 5160-19-01 of the Administrative Code to be eligible for patient centered medical home (PCMH) payments. (B) A CPC entity participating in the CPC for kids program has to be enrolled as a CPC entity and meet all provisions set forth in rule 5160-19-01 of the Administrative Code to be eligible...

...The "comprehensive maternal care (CMC) program" is a maternal and infant support program that utilizes a comprehensive care coordination and service model incorporating supportive services for expectant and postpartum medicaid eligible individuals to reduce adverse birth and infant outcomes. (A) For purposes of Chapter 5160-19 of the Administrative Code, the following definitions apply: (1) "Attribution...

...The "comprehensive maternal care (CMC) program" is a maternal and infant support program that utilizes a comprehensive care coordination and service model incorporating supportive services for expectant and postpartum women to reduce adverse birth and infant outcomes. (A) For purposes of Chapter 5160-19 of the Administrative Code, the following definitions apply: (1) "Attribution" is the process thr...

...(A) Definitions. (1) "Abuse potential drug" as used in the appendix to this rule, means any drug that contains substances which have a potential for abuse because of depressant or stimulant effects on the central nervous system or hallucinogenic effects. Abuse potential drugs include any drug that is reportable to Ohio automated RX reporting system (OARRS) as described in rules 4729:8-2-01 and 47...

...(A) Definitions. (1) "Abuse potential drug" as used in the appendix to this rule, means any drug that contains substances which have a potential for abuse because of depressant or stimulant effects on the central nervous system or hallucinogenic effects. Abuse potential drugs include any drug that is reportable to Ohio automated RX reporting system (OARRS) as described in rules 4729:8-2-01 and 47...

...(A) Definitions. (1) For the purposes of this rule, "hysterectomy" means, in accordance with 42 C.F.R. 441.251 (October 1, 2010 edition), a medical procedure or operation for the purpose of removing the uterus. (2) For the purposes of this rule, "institutionalized individual" means, in accordance with 42 C.F.R. 441.251 (October 1, 2010 edition), an individual who is: (a) Involuntarily confined or detained, under a...

...(A) Coverage. (1) Unless a different time period is specified, services described in this rule are covered through the pregnancy and the delivery. (2) Basic pregnancy-related services include but are not limited to antepartum care, delivery, outpatient postpartum care, and family planning services. (a) Antepartum care. Payment for a visit may be made for either of two purposes: (i) Basic...

...(A) Coverage. (1) Unless a different time period is specified, services described in this rule are covered through the pregnancy and the delivery. (2) Basic pregnancy-related services include but are not limited to antepartum care, delivery, outpatient postpartum care, and family planning services. (a) Antepartum care. Payment for a visit may be made for either of two purposes: (i) Basic...

...(A) Coverage. (1) Unless a different time period is specified, services described in this rule are covered through the pregnancy and the delivery. (2) Basic pregnancy-related services include but are not limited to antepartum care, delivery, outpatient postpartum care, and family planning services. (a) Antepartum care. Payment for a visit may be made for either of two purposes: (i) Basic...

...(A) Unless otherwise noted, any limitations or requirements specified in the Revised Code or in agency 5160 of the Administrative Code apply to services addressed in this rule. (B) Definitions. (1) "Advanced practice registered nurse (APRN)" has the same meaning as in Chapter 4723-08 of the Administrative Code. (2) "Registered nurse (RN)" has the same meaning as in Chapter 4723. of the Revised ...

...(A) Unless otherwise noted, any limitations or conditions specified in the Revised Code or in agency 5160 of the Administrative Code apply to services addressed in this rule. (B) Definitions. (1) "Advanced practice registered nurse (APRN)" has the same meaning as in Chapter 4723-08 of the Administrative Code. (2) "Registered nurse (RN)" has the same meaning as in Chapter 4723. of the Revised ...

...(A) Unless otherwise noted, any limitations or conditions specified in the Revised Code or in agency 5160 of the Administrative Code apply to services addressed in this rule. (B) Definitions applied to this rule. (1) "Eligible provider" has the same meaning as defined in rule 5160-1-17 of the Administrative Code. (2) "Family connects" is an evidence-based home visiting model that provides...